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Devoted EXTRA Florida (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted EXTRA Florida (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted EXTRA Florida (HMO) in 2025, please refer to our full plan details page.
Devoted EXTRA Florida (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Lake, Marion, and Sumter Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Devoted EXTRA Florida (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Devoted EXTRA Florida (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Devoted EXTRA Florida (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Devoted EXTRA Florida (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the following costs. For Tier 1 drugs, there is no copay at either standard or mail order pharmacies. For Tier 2-4 drugs, you pay 25% coinsurance at both standard and mail order pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay no costs for Part D drugs.
Additional Benefits
The Devoted EXTRA Florida (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $175 copay for the first five days, then no copay. Outpatient services have copays ranging from $0 to $175, and emergency services cost $140. The plan includes coverage for primary care, vision, dental, and hearing services. Primary care, specialist visits, and hearing exams have $10 copays. Vision services include routine eye exams and eyewear, and dental services have a $10 copay with a $1,250 annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric benefits, both requiring prior authorization. For Inpatient Hospital-Acute, you will pay a $175 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will also pay a $175 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades are not covered. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted EXTRA Florida (HMO) plan. Ground ambulance services have a copay between $0 and $300, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted EXTRA Florida (HMO) plan, with a $140 copay. Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services have a $140 copay for Worldwide Emergency and Urgent Coverage, and a $300 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted EXTRA Florida (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $10-$50 copay, physician specialist services with a $10 copay, mental health specialty services with a $10 copay, other health care professional services with a $0-$10 copay, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with a $10-$50 copay, additional telehealth benefits with a $0-$10 copay, and opioid treatment program services with a $10 copay; routine chiropractic care is not covered, and a doctor referral is required for physician specialist services, other health care professional, and additional telehealth benefits.
Preventive Services See details
Preventive Services are covered by the Devoted EXTRA Florida (HMO) plan, including no copay for Medicare-covered preventive services, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. In-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, and routine hearing exams are limited to one per year. Prescription hearing aids are covered with a copay between $399 and $699, and are limited to two per year, while fitting and evaluation for hearing aids is unlimited. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a $10 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with a combined maximum benefit of $1250 per year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $10 copay, as well as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. Orthodontic Services are covered under Diagnostic and Preventive Dental, while Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a $1,250 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted EXTRA Florida (HMO) plan. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0%-25% coinsurance and no copay, Prosthetic Devices with 0%-20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Devoted EXTRA Florida (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted EXTRA Florida (HMO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted EXTRA Florida (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services, like acupuncture, over-the-counter items, meal benefits, and several others, are not covered. However, the plan covers "Other 2" benefits with no copay for preventive services.
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